Provider Demographics
NPI:1043265333
Name:BERGETHON, PETER ROALD (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROALD
Last Name:BERGETHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 BRETTON RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2503
Mailing Address - Country:US
Mailing Address - Phone:617-638-4108
Mailing Address - Fax:617-638-4216
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:TUFTS-NEW ENGLAND MEDICAL CENTER #314
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-5848
Practice Address - Fax:617-636-8199
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA558962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology